Diabetic retinopathy and microalbuminuria in lean type 2 diabetes mellitus.

BACKGROUND: Relationship between microalbuminuria and diabetic retinopathy in patients with type 1 and type 2 diabetes mellitus has been described. Patients with lean type 2 diabetes mellitus has some difference of insulin secretion and action in comparison with obese type 2 diabetes mellitus and there are evidences to support that lean type 2 diabetes mellitus is slow emerging type 1 diabetes mellitus in our population. The aim of this study is to find out correlation between retinopathy and microalbuminuria in lean type 2 diabetes mellitus. METHODS: Fifty two patients with lean type 2 diabetes mellitus (BMI < 18.5 Kg/M2) were selected. Diabetic retinopathy was observed in 25 patients only. Blood glucose sample was taken after 10 hours of overnight fasting. Glycosylated haemoglobin (HbA1c) was measured by calorimetric method and urinary albumin was estimated in morning urine saniple by Micral II test strip. RESULTS: Patients with diabetic retinopathy had longer duration of diabetes detected than those with normal fundus but the difference was statistically insignificant. Fasting blood glucose greater than 200 mg/dl was found in 63.6% of patients with diabetic retinopathy and in 36.4% of patients with normal fundus but the difference was insiginificant. Patients with diabetic retinopathy had microalbuminuria test positive and level was significantly higher in patients with proliferative retinopathy than in patients with background retinopathy. CONCLUSION: Microalbuminuria is associated with diabetic retinopathy in lean type 2 diabetes mellitus. Increase in urinary albumin excretion correlates with development of proliferative diabetic retinopathy in lean type 2 diabetes mellitus similar to type 1 and type 2 diabetes niellitus. This study emphasizes that microalbuminuria estimated by semi quantitative method is a cost effective and reliable marker of diabetic retinopathy in lean type 2 diabetes mellitus and high level of this may serve as an indicator of proliferative retinopathy in them.

[Clinical value of urinary pyridinium crosslinks as osteoporosis markers: evaluation of a population survey of vertebral osteoporosis]. / Sind Crosslinks klinisch aussagekräftige Osteoporosemarker? Evaluation in einem Bevölkerungsquerschnitt.

BACKGROUND: The diagnostic value of biochemical parameters of bone turnover for the diagnosis of osteoporosis is open to discussion. We investigated whether the determination of crosslinks, bone type I collagen degradation products, correctly identifies osteoporotic subjects. PATIENTS AND METHOD: In a sample of 370 individuals recruited at random within a population survey of vertebral osteoporosis, urinary concentration of total pyridinoline and desoxypyridinoline were determined by HPLC. Standardized lateral X-rays of the thoracic and lumbar spine were taken and evaluated morphometrically using the method described by Eastell-Melton. RESULTS: Crosslink excretion was significantly higher in female but not in male individuals with vertebral deformities as defined by Eastell. The specificity of these biochemical parameters with regard to radiological osteoporotic alterations was 76-81%, but the sensitivity was 32.4-42.9% only. CONCLUSION: Pyridinoline and desoxypyridinoline reflect the process of bone degradation which leads to vertebral deformity. Crosslinks are specific markers of bone resorption and provide a valid parameter in the diagnosis of osteoporosis. The low sensitivity indicates that the measurement of pyridinoline and desoxypyridinoline is less suitable for screening purposes, but may be useful in confirming presence or extent of osteoporosis.